重症医学科医院内感染病原学现状调查及耐药性分析

发布时间：2018-01-19 04:29

本文关键词： 医院内感染 ICU 多重耐药菌病原菌　出处：《河北医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:1了解沧州市人民医院重症医学科(Intansive Care Uint,ICU)医院内感染患病率和感染部位分布情况;2了解我院ICU医院内感染的病原学现状、病原学的流行病学特征及其耐药性;3探讨医院内感染与侵入性操作的关系;4探讨一系列感染防控措施对重症医学科(ICU)医院内感染及多重耐药菌耐药情况的影响,为预防控制ICU院内感染提供依据。方法:1对ICU 2013年1月至2014年12月1269例住院患者进行回顾性调查,根据调查内容设计登记表;2采用前瞻性方法从2014年1月开始,实行ICU医院感染管理目标监测,建立ICU医院内感染病例日志;3查阅ICU院感管理档案,根据上报院感科的《院内感染登记表》的相关数据和病历资料,整理2013年1月至2014年12月ICU 170例发生医院内感染患者的临床资料,包括一般资料及感染日期、侵入性操作、感染部位、病原学及其耐药性。4用Excel软件建立数据库,统计分析采用SPSS17.0软件。计数资料用率或构成比描述,计数资料的比较采用卡方(χ2)检验。以P0.05为差异有统计学意义。结果:1 2013年-2014年ICU发生医院内感染患者170例,感染例次254例次,医院感染率13.40%,医院感染例次率20.02%。2常见感染部位依次为下呼吸道(53.94%)、泌尿系(23.63%)、血液(15.35%)、腹腔(2.36%)、胸腔(2.36%)、手术切口(1.18%)。3呼吸机相关性肺炎、尿管相关泌尿系感染、导管相关血流感染与“三管”侵袭性操作有直接关系(P0.05)。4 2013-2014年医院内感染患者共分离出419株菌株,主要来源于痰培养248株,占59.19%;其次为尿培养68株,占16.22%;血培养46株,占10.98%;导管培养39株,占9.31%;胸水、腹水、手术切口等其他共18株,占4.30%。其中革兰阴性菌267株,占63.72%;革兰阳性菌110株,占26.25%;真菌42株,占10.03%。院内感染病原菌总体排名前五位分别为鲍曼不动杆菌15.75%(66/419),铜绿假单胞菌14.08%(59/419),大肠埃希菌11.93%(50/419),金黄色葡萄球菌8.83%(37/419),肺炎克雷伯菌8.35%(35/419)。2014年与2013年比较,多重耐药菌中铜绿假单胞菌的耐药菌分离率有所上升,其它分离率50%的几种多重耐药菌分离率都呈下降趋势,具有统计学意义。多重耐药菌对常用抗生素存在多重耐药,革兰阴性菌对头孢吡肟耐药率较前上升。结论:ICU医院内感染率较高,感染部位以下呼吸道为主,呼吸机使用天数、保留尿管天数、中心静脉置管保留天数、抗生素应用与多重耐药菌感染存在密切关系。ICU医院内感染分离出病原菌以革兰阴性杆菌为主,且多为多重耐药菌,分离出的院内感染多重耐药菌对常用抗生素的耐药情况不同,耐药率有明显变化。2014年与2013年相比较,加强院内感染防控措施,院内感染发病率无明显改善,考虑分析与多重因素有关,包括病情危重程度,平均住院日等有关。
[Abstract]:Objective to investigate the prevalence and distribution of nosocomial infection in the Department of intensive Medicine (ICU) of Cangzhou people's Hospital. (2) to understand the etiological status, epidemiologic characteristics and drug resistance of ICU nosocomial infection in our hospital. 3To explore the relationship between nosocomial infection and invasive operation; 4 to explore the effect of a series of infection prevention and control measures on nosocomial infection and multidrug resistance of ICU. To provide the basis for preventing and controlling the nosocomial infection of ICU. Methods: a retrospective survey of 1269 inpatients with ICU from January 2013 to December 2014 was carried out. Design registration form according to the content of investigation; (2) from January 2014, ICU hospital infection management objective monitoring was carried out, and the ICU nosocomial infection case log was established. (3) to consult the hospital sense management files of ICU, according to the relevant data and medical records of the nosocomial infection registration form reported to the hospital feeling department. The clinical data of 170 ICU patients with nosocomial infection from January 2013 to December 2014 were collected, including general information, date of infection, invasive operation and site of infection. Excel software was used to establish the database of etiology and drug resistance. SPSS17.0 software was used for statistical analysis. The data consumption rate or composition ratio was described. The count data were compared by chi-square test (蠂 ~ 2) test. The difference was statistically significant with P0.05. Results from 2013 to 2014, 170 patients with ICU had nosocomial infection. 254 cases were infected, the nosocomial infection rate was 13.40%, the nosocomial infection rate was 20.02.2% and the common infection site was lower respiratory tract (53.94). The urinary system was 23.63m, the blood was 15.35m, the abdominal cavity was 2.36m, the thoracic cavity was 2.36cm, the operative incision was 1.180.3. ventilator-associated pneumonia. Urinary tract infection associated with catheterization. A total of 419 strains were isolated from patients with nosocomial infection in 2013-2014. There was a direct relationship between catheter-related blood flow infection and invasive operation of "three tubes". 248 strains of sputum were mainly derived from sputum culture, accounting for 59.19%. The next was urine culture 68 strains (16.22%); 46 strains (10.98%) were cultured in blood. 39 strains (9.31%) were cultured through catheter. There were 18 strains of hydrothorax, ascites, surgical incision and so on, accounting for 4.30.The gram-negative bacteria accounted for 267 strains (63.72%); There were 110 Gram-positive bacteria (26.25%); There were 42 strains of fungi, accounting for 10.03.The top five pathogens of nosocomial infection were Acinetobacter baumannii 15.7566 / 419 respectively. Pseudomonas aeruginosa 14.08 involved 59 / 419, Escherichia coli 11.93 / 419, Staphylococcus aureus 8.83 / 419). Klebsiella pneumoniae 8.35 / 4190.Compared with 2013, the isolation rate of Pseudomonas aeruginosa from multidrug resistant bacteria increased in 2014. The isolation rates of other multidrug resistant bacteria with 50% were decreased, and there was statistical significance. The multidrug resistant bacteria were multidrug resistant to common antibiotics. Conclusion the nosocomial infection rate of Gram-negative bacteria to cefepime is higher than that of the former. Conclusion the infection rate in the hospital is higher. The respiratory tract below the infection site is the main infection site, the days of ventilator use, and the days of retention of urinary catheter. There was a close relationship between antibiotic use and multidrug resistant bacteria infection. Gram-negative bacilli were the main pathogens in ICU hospital infection, and most of them were multidrug resistant bacteria. The drug resistance of multidrug resistant bacteria isolated from nosocomial infection to common antibiotics was different, and the drug resistance rate was obviously changed. In 2014, compared with 2013, the measures of prevention and control of nosocomial infection were strengthened. The incidence of nosocomial infection was not significantly improved. The analysis was related to multiple factors, including the severity of the disease and the average length of stay.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R446.5

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